Healthcare Provider Details

I. General information

NPI: 1184935355
Provider Name (Legal Business Name): CRYSTAL LEACH LIMHP, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WEST 2ND STREET
OSHKOSH NE
69154-6152
US

IV. Provider business mailing address

1100 WEST 2ND STREET
OSHKOSH NE
69154-6152
US

V. Phone/Fax

Practice location:
  • Phone: 308-772-3283
  • Fax: 308-772-9916
Mailing address:
  • Phone: 308-772-3283
  • Fax: 308-772-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1486
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1077
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: